我国商业医疗保险的风险与风险控制研究

发布时间：2018-04-13 17:20

本文选题：商业医疗保险 + 风险　；参考：《苏州大学》2013年硕士论文

【摘要】：近年来，随着中央政府对民生问题关注度的逐步提高，解决群众医疗卫生问题作为保障民生的基本内容也得到了相应的重视，各级政府在相关决策中纷纷强调了居民健康问题的重要性，同时加大了对当地的医疗卫生投入。2009年4月，《中共中央国务院关于深化医药卫生体制改革的意见》出台，该方案鼓励企业和个人积极参与商业医疗保险，以满足人民群众对基本医疗保障之外的健康保险需求。这样一来，各级政府对居民医疗健康这一问题的高度重视为商业医疗保险的发展提供了政策支持，而新医药体制改革又从制度定位、发展方向、实现方式等方面为我国商业医疗保险提供了良好的发展空间。商业医疗保险作为医疗保障体系的构成部分，是对社会医疗保险的重要补充，在人口老龄化加剧、新的医疗设备和技术层出不穷的情况下，它可以满足人们日益增长的医疗服务需求，其作用不可忽视。近几年我国的商业医疗保险市场保持着较快的发展水平，医疗保险经营主体数量不断增加，产品种类繁多，覆盖面逐步扩大，但与人们的迫切需求相比，其发展还相对缓慢，发展过程中也显现出一些问题，风险客观存在。目前，缺少商业医疗保险风险控制方法已成为制约我国整个医疗保险发展的瓶颈，商业医疗保险经营成败的关键就在于能否做好风险控制工作。我国医疗保险尚处于初级发展阶段，，有关商业医疗保险风险及控制的研究才开始萌芽，为了促进我国商业医疗保险快速发展，必须对其存在的风险加以分析研究，并采取相应的措施来控制风险。本文以商业医疗保险的风险及风险控制为核心研究内容，综合运用保险学、信息不对称理论、博弈论等理论知识和方法，结合目前我国商业医疗保险发展现状及存在的问题，分析医疗保险市场存在的道德风险、逆向选择风险、费用支付方式风险和产品设计风险产生的原因、表现形式及危害，并运用博弈模型对道德风险进行了重点研究。通过分析国内商业医疗保险风险控制机制及其存在的问题，在借鉴国外经验和前人研究的基础上，本文提出了一系列符合我国商业医疗保险发展的风险控制思路和方法，包括推行管理式医疗模式、促进社会医疗保险与商业医疗保险之间的有效衔接、改进赔付结算方式、推广创新产品的设计等。
[Abstract]:In recent years, with the increasing attention of the central government on people's livelihood issues, solving the mass medical and health problems, as the basic content of protecting people's livelihood, has been given corresponding attention.Governments at all levels have emphasized the importance of residents' health problems and increased their investment in local medical and health care. In April 2009, the State Council of the CPC Central Committee and the State Council on deepening the reform of the medical and health system came out.The program encourages businesses and individuals to participate actively in commercial health insurance to meet people's needs for health insurance beyond basic health insurance.As a result, governments at all levels attached great importance to the issue of residents' medical care and health care, which provided policy support for the development of commercial medical insurance, and the reform of the new medical system was based on the orientation of the system and the direction of development.The realization way and so on has provided the good development space for our country commercial medical insurance.As an integral part of the medical security system, commercial medical insurance is an important supplement to social medical insurance. With the aging of the population and the emergence of new medical equipment and technology,It can meet the increasing demand of medical service, and its function can not be ignored.In recent years, China's commercial medical insurance market has maintained a relatively rapid development level. The number of medical insurance operators has been increasing, the products are various, the coverage is gradually expanding, but compared with the urgent needs of people, the development of medical insurance is relatively slow.In the process of development, there are some problems and risks exist objectively.At present, the lack of commercial medical insurance risk control method has become a bottleneck restricting the development of medical insurance in China. The key to the success or failure of commercial medical insurance management lies in whether or not to do a good job of risk control.China's medical insurance is still in the primary stage of development, and the research on the risk and control of commercial medical insurance has just begun to sprout. In order to promote the rapid development of our country's commercial medical insurance, it is necessary to analyze and study its existing risks.And take appropriate measures to control the risk.This article takes the risk and risk control of commercial medical insurance as the core research content, synthetically uses the insurance science, the information asymmetry theory, the game theory and so on the theory knowledge and the method, unifies our country commercial medical insurance development present situation and the existence question at present.This paper analyzes the causes, forms and harms of moral hazard, adverse selection risk, expense payment risk and product design risk in the medical insurance market, and focuses on the study of moral hazard by using the game model.By analyzing the risk control mechanism of domestic commercial medical insurance and its existing problems, this paper puts forward a series of ideas and methods of risk control in line with the development of commercial medical insurance in China on the basis of foreign experience and previous studies.It includes promoting the effective link between social medical insurance and commercial medical insurance, improving the settlement method of compensation, and popularizing the design of innovative products.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684

【参考文献】